How Much Will Trump Change MACRA?

BIDMC CIO John Halamka advised providers to stay the course on MACRA, while iHealth partner Justin Barnes agreed that major changes are unlikely. But Robert Tennant of the MGMA cautioned that we won’t know until Trump takes over.

Just a week after the election changes are already starting to take place in Washington in advance of the transition from President Obama to the administration President-elect Donald Trump is assembling. Physicians and healthcare executives are asking what impact, if any, the Trump Administration might have on the upcoming compliance with the final regulations under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its sub track, the Merit-based Incentive Payment System (MIPS).

Experts who spoke with Healthcare IT News said the MACRA regulation issued Oct. 14 and designed to change how healthcare providers are reimbursed under Medicare will remain largely intact.

Not only did MACRA enjoy wide bipartisan support at its passage, but the concepts behind it were originated by Republican members of Congress more than a decade ago, said Justin Barnes, a partner at iHealth.

“The tenets of accountable care are sound,” Barnes said. “Anybody in power, or educated on this topic, is in support of SGR Reform through MACRA.”

Barnes, who spent more than a decade on Capitol Hill educating Congress on health IT issues, said he expects the Trump administration to issue more guidance on MACRA in 2017, but he doesn’t anticipate any dramatic changes.

Further, there is no real controversy surrounding the demands it places on physicians, he added.

Barnes attributed the widespread support behind MACRA to Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), for “doing a good job of listening” to the concerns of stakeholders and for creating the flexibility that healthcare providers needed to comply with the regulations.

“MACRA is legislation not regulation and so that can only be changed by an act of Congress,” Halamka said.

Halamka added that he has spoken with several career employees of the Obama administration who have worked on MACRA regulations and who will carry over their work into the Trump administration, and he has the sense that a lot of what has been put into place based on legislation will stay the same over the next few years.

“Stay the course,” when it comes to MACRA, Halamka advised healthcare providers. “All of the big data analytics and system support that we’ve planned for the last couple of years will hold us for the next couple of years.”

Robert Tennant, director of health information technology policy for the Medical Group Management Association (MGMA) is more speculative. As with all laws, they are basically a canvas for an agency to work with; the regulations are painted in by regulators, Tennant said.

The Trump administration will ask if there is value in the MACRA reporting requirements, and if there isn’t sufficient evidence that there is, there might be changes, Tennant said. “One never knows until the new players are in place.”

The 2018 changes to the MACRA regulations are expected to be a more challenging. If the Trump administration were inclined, there could be tweaks to those requirements, Tennant added.

Tennant, however, put forth this caveat: Because MACRA passed by overwhelming majority in both the House and the Senate, a GOP administration will be less likely to want to make changes. Tennant said he has observed through the years that every administration wants to make some changes to the previous administration’s work. “It just depends on the person at the helm.”

Tennant spoke with CMS career staff last week and a lot of them have been through several changes in administrations. They said in essence that they will keep their nose to the grindstone, whoever is in charge.

“Republicans are proud of MACRA, they talk about MACRA a lot,” said Blair Childs, senior vice president of public affairs at Premier, Inc. Because it’s something the GOP supports, Childs doesn’t predict changes to be made to it. “I don’t think they’ll do a lot that will change what’s in MACRA.”

Plus, the way things stand now the Trump administration will be too busy concerning themselves with the repeal of Obamacare to worry about MACRA, according to Michael Millenson, president of Health Quality Advisors.

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